HomeMy WebLinkAbout010-841-17-3401-SAN-2020-146IndusBy Services DiviBion1400 E Waahington AveP.O. Box 7162,WI53707-7162M. cyr-7162>.Sanitary Permit ApplicationIn accordance with SPS 38321(2), Wi», Ada. Code, lobmiasiOD ofthit fbim to the qvptopriate govBmneatal tai!u nquiied prior to obtiiaiag a loitBy pamh. K«e; Applicaioa fbmu for ftst^cwoed POWTS m nbmitted tothe Oepaitasn of Safety and Prnfraawnal Ssvleea. Poaonal infonnaiion you provide may be for aecondBvpurpoeea in acccrdanee witfa the Priv^ Law, i. IS.CWlVml Sr«r«' ' —■ '—CotBitySanitaty Permit Noaber (to be filled in by Co.)State TranaaciiooNumberL Applterton Informntlon - Plee»e Mnt AC TnfonnetionProperty OProject Addreea (ifdiffomt than addreee)wner'e NameiQowV jpr"ftopeny Owner't Mailins Addrm\ O AJ t\J y vv-\ji.jsJ A CJ £-City, StateVWvC^U-ZipCodeIL Type of BaUdlng (check ell tfaet apply)or 2 Family Dwelling - Numbw ofBedioomi0 Pnblic/Cotsmocial - Deaeribe Ute.D State Owned-Deaoibe UseFbone NumberLot#Block#CSMNtlmberniTypeofPenntt; (Cheekoaly oneboxoa line A. Complete Use B Ifapplicable)Parcel#73'/orProperty LoetfieoQqvt. LotVi. £> V4. SectionT HI(circle one).N; R 8 Eotd^XZ.SnbdivisiaoNtme□ Civ Of.□ m«eof.CTownofB.n NewSyitemD ^rstit RenewalTiefree EiqtiiitionR^laeement SystemQ Pennh Reviiioe0 Tteetment/Holding Tank Replacement Only0 Change ofPhimberIV. Type ofPOWTS Syitem/CoinDonent/Devicet (Cheek ell apply□D Permit Transfor to NewOwner0 Odm- xtmlififtgiilw »n nywwLilt Previooa PermitNumber md Date lened Non-Premuriaod In-Ground □ Preeauriaed In.Oround □ Al-Grwle □ Mound >24 ia of suitable soil Q Mound <24in. ofsuiliblisoilyHoldingTank □ Odw Diipertal Compcrteat (eiylain) □ Pimimih.#,!. Device (escplain)V. DfeneeeaVrreatw**"* *»■<■ Tnfapmftnii.Design Flow (gp^Deeiffi Soil AppUcmiao Rett(gpdif)VI Tnak InfoSeptic <s Haldiaf TnlcDoiiag Ousin1.eieCqiadV foQiUo&sDispeisil Area Required (ef)NewTeektS o<sxj>Bsidai TaakiTotalGallonsXcx'f#ofUnhaDispersal Area IhopoMd (af)Manu&cturerSyston ElevatioBA-^/t1^k O'IEVIL Retponslfaillty Statement- L the mder^fd. amnmereeponalMmy for farstnlletlenefthe POWTS riiown en die attacW*^ p»«"'Plumber's NamPlMP^lFRS Ne (Print)Jerry Ruld Excavating, LLCunlw^ Signi&BOstone Lake. WI 54876umberBuuitea Phone NumberH0& (County/Department Uee OnlyI U Owner Given ReSMn fig Denial |DC Conditions ofApproval/Reasons for DisapprovalD DisqrprovedD Owner GrveD Rsaun fiv DentalPennh FeeSHoc,CODettltfuedI Agwif ■7-c?^-yk&hit^Habitatieliving areashall not be createdin accessory structuresORIGINALNO REFUNDS AFTERISSUE OF PERMITAttBch to coapleie piaai for Ibe eyeieg ud nbBtt IS foe Ceanty eaty ea paper net kes tkan 81/1 a 11 tnchw ta'SBD-6398 (R. 08/14)qAWYER COUNTYZONING administration
Sawyer County Zoning & Conservation Administration10610 Main Street, Suite49Hayward, Wisconsiti54843('15K'34-X288>'A.X(7IS)A3K-3277^ « ww.>tiwvcrL-»iiiitvgov.orgy o ^ L'fnatI; /oning. isawvcrcouiilvbov.i>r^^ Courthauje/Cicncral Information l«877-699-^l in-CoS,>\\rvOSanitary Cover SheetPlot PlanHolding Tank Approval Checklist/or Sheet Date Stamp 0~? /Parcel IDft O \ o . f t/ f . \ 7 -3 V O (X Property LinesSite Addressy Stmcturey Well✓^eaal DescriptionSA Benchmark BM s_Z North Arrow^ ScaleX<25' to Service Road^v^^earest Road Intersectionetbacks to: Property Line, Well, Striiclurc, Water bodies, RoadsHI. Required PlansIndex Page with Original SignatureManagement Plan/Contingcncy PlanyServicimz Contract_XHolding Tank Agreement formIV. Holding Tank Specifications)C Cross-section - Manufacture, Gallons: <^OCP_2^Tank Anchor Calculations [SPS 383.43 8) g)]y Locking device, chains/locksyAlarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andSlate Statutes 101.862(2) and 101.862(3)yC. 3" Bedding Material < 1/2 "V. Holding Tank Plans per Component POWTS Manual_X Version 2 SBD-I0855-P (R.3/07)Owner:Application Review Date:POWTS Reviewer:Plumber:7f6=r 51,(1Revised 4/11/2013
Pg 1 of 4Pg 2-^aPg 3of4Pg 4 of 4Attachments:Holding Tank PlanIndex & Cover SheetComponent Manual Design References:Version 2.0, SBD-10856-P (N. 03/07; R 01/12)Index & Cover SheetPlot PlanHolding Tank SpecificationsManagement PlanEnclosures:PAGE 1 OF 4POWTS Application for ReviewSoil Evaluation Report & Site Map (if applicable)Holding Tank Pumping Contract (if applicable)Holding Tank Agreement (if applicable)Project Name I DescriptionOwnerName(8): y Phone: .Owner Address: Jo6o3/\^ VWy zip: fi *<3Project Address: u/ Uwv 77Govt Lot: 1/4 of 1/4, Section i? . T V/ U-R<=>& E □ or W 0Township: —Ha^v \Aj<s^rci County: Sy-tirf—Project Parcel ID #: 11 IZHd IDesigner InformationDfifiianAr Namtt- RuW EXCSVatlng, LLCDesigner Name, waoo County IIWY ADesigner Address: Stone Lake, W154878E-mail:Phone:Zip:This space reserved for appLicense Number:Remarks:roval stamp.Signature: Q , 6^0^f /^glnal signatureiglnal signaturerequired on each submitted copy.Date: 7- ^.i-Zoj.c?
wo'(vJ UJK c o<s>t~-~\.U»«*SoHoA- URp &ot3<aA->- ofSt'tii/Ballet— /OCtCJiA>t^ "iC,, 7To^k. s L-Tii.NNoTiS. 1 A- it phspar-f-y«.hc_ •+--tc rfs-eM^ ^e.TbcuU:s.o6A'r\iX>n>^Q.o — ^/os^-r^p-Jerry Ruld Excavating, LLCW208 County HWYAStone Lake, Wi 54870' ZL y-s,? c^NU-vior-^ oSo^ M W^tAo.Jvj >4oe^~S"'<i5k'3
PAGE 3 OF 4HOLDING TANK SPECIFICATIONS(No Scale)EtecMcal must complySPS 316 and NEC 300^[IS'Mln.(typical)O Weatheipmof—JimcdonandAlarni Box-Conduit4*0 Vent Pipe>10 ft from —VBunding \12'Min.or^OftabovGAmrmind EstabBshed Flood ElevationvK; / evp""')1 / Approved Locking Manhole' with Waming Label Attached(AApproved Joints MthApproved Pipe 3 ft ontoSolid QnundInletAMghtSeal\1/« .Inlet InvertMax. 12* or S0% of total volume^ I If more than one tankAlamvOnHOLDING TANKVOLUME =gal3* Approved Bedding Mateifal Beneath Tanktyi^l)4'Mln.orZOftaboyeEstablished Flood Elevation(typical)\i/ \l/Finished GredoWatertightPlugTANK MANUFACTURER;Anchor tank as necessarypursuant to SPS 383.43(8)(g)Ballast Weight = [(cu.fttank.vol x 62.4 lt)s/cu.ft) - It>s.tank.wl3 x 1.5Ballast Weight = [( cu.ft. x 82.4 Ibs/cu.ft) - lbs] x 1.5 = ips
PAGE 4 OF 4Holding Tank Management PlanIMPORTANT:The owner of this holding tank(s) shall be responsible for Its perpetual operation and maintenance pursuant torequirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this holding tank(s)shall be considered a human health hazard if not maintained In accordance with tMs approved management [^an.Furthermore, all Inspection and maintenance activities shall be performed by a registered POWTS Malntainer inaccordance with SPS 383.52 (3), Wisa Admin. Code.Estimated Dally Wastewater Flow = gpdInsnaetlon Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors {I.e. odors, user complaints, efc.)o mechanical malfunction (/.e., pumps, valves, swit^es, floats, efc.)o material fetigue {i.e., ieate, break^ comosion, etc.)o neglect or improper use (/.e., exceeding design capacities, prohibited activities, etc.)o electrical ccxnponents {/.e., wiring, connections, switdies, controls, timers, alarms, etc.)o surface discti^e of effluent or sewage iiack-up Into structure servedSERVICING FREQUENCYo The tank(s) shall be pumped by a certified septage sen/Icing operator licensed under s. 281.46 Wise. Stats,when the wastewater in the tank(s) reaches a ievei of one foot beiow the iniet invert of the tank(s).Disposal of contents shall be pursuant to NR113, Wise. Admin. Code.Tank pumping reports shail be submitted to the proper iocai government unit in aooordanoe with SPS 383.55 Wls.Admin. Code. Ri^ort any component faiiure or maifunotion to:Name of individual or company: C— Phone: 70.1^Local government unit Phone: "7^^"" 3^**LocalgovwTwnerrturtitaddress: IQtbiO S7T Softig.* (UaT^ZiP: ■S'MAny defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin.Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code.No product for chemical or physical restoration of the POWTS may be used unless approved by the department inaccordance with SPS 384, Wise. Admin. Code.Continaencv Pianin the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to aplan submitted to the appropriate agecy for review and approval.System AbandonmentIf use of this tank(s) is discontinued, it shall be abandoned In accordance witti SPS 383.33, Wise. Admin. Code.
HOLDING TANK SERVICING CONTRACTContract Date:/ac-/ ac:2oThis contract is made between the Holding Tank Owner and the Pnmper.Holding Tank Owner's Name:Puaqaer's Name:Parcel Identification Number:(12 Digit Lesacv ID) Ci \C>-& Y / -J_ 7 - 3 Vo 14.The owner agrees to file a copy of this contract with the governmental unit, Sawyer County,which has accepted and recorded with the Office of the Register of Deeds, the Maintenance^eement for a Holding Tank required under the Sawyer County Private Sewage SystemOrdinance for the issuance of a Sanitary Permit for the installation of a holding tank(s).The owner agrees to have the holding tank(s) serviced by the pumper and guarantees topermit the pumper to have access and to enter upon the property for the purpose of servicingthe holding tank(s). The owner agrees to maintain the all-weather access road or drive sothat the pumper can service the holding taiik(s) with the pumping equipment. The ownerfurther agrees to pay the pumper for charges incurred in servicing the holding tank(s) asmutually agreed upon by the owner and punqier.The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for theservicing of the holding tank(s) as required under SPS 383.55, Wisconsin AdministrativeCode and the Sawyer County Private Sewage System Ordinance. The punqier furtheragrees to include the following in the report:a. The name and address of the person responsible for servicing the holding tanV-b. The name of the owner of the holding tank;c. The site address of the holding tank;d. The dale the holding tank was serviced;e. The volumes in gallons of the contents pumped from the holding tank for each servicing;f. The disposal sites to which the contents from the holding tank were delivered.This agreement will remain in effect until the owner or pumper terminates this contract. Inthe event of a change in this contract, the owner agrees to file a copy of any nhangiM; to thisservice contract or a copy of a new service contract with Sawyer County within ten (10)business days from the date of change to this service contract.Owner's Name: (Print)Owner's Signature: (Only oat 0WB«r t^naoire nqaired)Pumper's Name: (Print)Pui^ier's Signatsire:Pumper's Registration Number:Rev. 03/26/13
Real Estate Sawyer County PropertyListingToday's Date: 7/21/2020Property Status: CurrentCreated On; 2/6/2007 7:55:19 AM^ DescriptionUpdated: 12/20/2019^ OwnershipUpdated: 12/20/2019Tax ID:11045JOSEPH S & KATHERINE MHAYWARD WIPIN:57.010-2-41-08-17-3 04-000-otiooioNAYLOR1 Legacy PIN:010841173401Billing Address;Mailing Address:Map ID:.12.1JOSEPH S & KATHERINE MJOSEPH S & KATHERINE MMunicipality:(010) TOWN OF HAYWARDNAYLORNAYLORSIR:Description:S17 T41N R08WSESW10803N NYMAN AVEHAYWARD WI 5484310803N NYMAN AVEHAYWARD WI 54843Recorded Acres;40.000Lottery Claims:0Jr Site Address * indicates Private RoadFirst Dollar:No14054W STATE HWY 77HAYWARD 54843Zoning:(A-1) Agricultural OneESN:444Property AssessmentUpdated: 4/16/2020^ Tax DistrictsUpdated: 2/6/20072020 Assessment DetailCodeAcresLand Imp.4,700 01State of WisconsinG4-AGRICULTURAL34.00057Sawyer CountyG8-AGRICULTURAL6.0005,100 0010Town of HaywardFOREST572478Hayward Community School District001700Technical College2-Year Comparison20192020 ChangeRecorded DocumentsUpdated: 7/16/2019□ WARRANTY DEEDDate Recorded: 6/28/2019Q WARRANTY DEEDDate Recorded: 4/8/2019a WARRANTY DEEDDate Recorded: 2/1/2005418492417170328318Land:Improved:Total:Property History10,QQ0010,0009,80009,800-2.0%0.0%-2.0%N/Ahltp://las sawyercounlyqov.org/Access/masier.asp7/21/20, 12:43 PMPage 1 of 1
•USE BUCK INK ONLY-0 3 3 2 7 6Tx;4021484POWTS MAINTENANCE AGREEMENTFor Holding Tanks425210PAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY, WIywner s Name{8) as shown on deed;07/23/2020 08:57 AMRECORDING FEE 30.00r-arcei laentitwaOon Number —(12Di9RLeBBcylD) ^J_-J_J. 3 OJ_PAGES: 2Legal uescnpton of Property: ~n SEE ATTACHED SHEET -We aGknovriedge that appUcatkM is being made for the Installation of a holding tankts) on theproperty descnbed on the attached sheet.Retum To; Consery«ion AdmlnlstrWlon10610 Main 8t Suite 48, Hayward, WIS484)appllcbls »,uire™„,P SPS 383, W.. AP™. Lr^niZ.riSS "'1S.2.3.4.5.iSfSSS~=~~=»=-^^conbac., wllh the go,.mma„te, „„»««„ ten (,0) busing da^ tamT ?atfof1ES."Ta°'a.™^°S'„M"™'J.^rmSnr„";ssr„4s°sVsnr88"ts«te™c;,;^'^Ah"^^^exemption underSection 281.48 (3) (d) Stals the owner shall l"^<»8eofSdSS;i't^bara'Snl^S taza™s'iSbrn''Sn°lM 1' "» •» P^ventand sen/ice. or cause the tank to be serviced. Pursuant to Section ul"2rrcs:'L'r;:i,s i;SLr,iteTs=r»wfje,S'^iZrlo'S "" T"'"" '""'= °™"' »Pl3n»P»'«» o»n«r. The owner shall sobmitf^islsr of dseds, and the agreement shall t>e recorded by the register of deeds In a manner wttich willpermit the existence of the agreement to be determined by reference to the property where the holding tank is InstaUed.Own^ Sign^re^^WIPU *Owner's Name (Print):S /Oixi.p''Date:I*: *Drafted by:'^c£,&pU KSK-V(b)r-\4.-p« uow»ACKNOWLEDGMENTState of: [AJl^hn^/U]b89^bed and sworryto before me on this.day of ^Jlj.l\j , 20 ^• %3[0wner's Name): uf)Nciary Public Signature;Notary Name (Print):commission expired on:"lll\\\\W>^^I/-2.0. 20Personal Informatton you provide may be used for secondary purposes [Privacy Law, § 15.04(1) (m)]Rev. 03/26/13
The Southeast Quarter of the Southwest Quarter {SEVaSWA),Section 17, Township 41 North, Range 8 West, Sawyer County,Wisconsin.